Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus / by Thomas Stephen Cullen.

  • Thomas Stephen Cullen
Date:
1916
Catalogue details

Licence: Public Domain Mark

Credit: Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus / by Thomas Stephen Cullen. Source: Wellcome Collection.

    64/714 (page 36)
    Between these three main types can be found a large variety of intermediary forms. Sometimes, even after careful examination, one would hesitate to determine to which class a given umbilicus belongs. Bert and Viannay’s figures are as follows. Instances of— 1S cErensverse Um biiCaae vied seni acon i oes. eee gk) oe 71 cases 2, .OUnG In buIcus 5 eee Se a EN aie ONE BP ATER TS tab, As eae 8 Se gV CLtICAl ITALICS ee a ee eo eR te oe tS Kak Om kta ie), he Be Lone. They examined systematically the umbilical cicatrix in all patients coming under their care. They regard the umbilicus as a cutaneous depression,—a sort of retracted cone,—in which one is able to distinguish the base, open in front and continuous with the skin of the abdomen. The bottom, or the summit, according to the point of view, is adherent, and is formed by the umbilical cicatrix and the surrounding parts. They also drew attention to the fact that Catteau had spoken of four constituent elements—a cutaneous cushion or collar, which corresponded to their base; an elevation or mamelon, which corresponded to their bottom and which carried the cicatrix; and, finally, a furrow or groove. They pointed out that the four elements are present in an occasional umbilicus, which they would then speak of as t he complete umbilicus, but that this complete umbilicus is met with in less than half of the cases. For example, in 112 molds Bert and Viannay found the umbilicus 34 times devoid of a central mamelon, and 21 times without a surrounding cushion, but as the cushion and the mamelon, or teat-like elevation, are divided by the furrow, when one of the two elements or when both are absent, the depression is also absent. The absence of one or more of these constituents of the umbilicus creates multiple combinations, which are capable of producing a certain number of types—a type of umbilicus without cushion or mamelon, a type with cushion and without mamelon, a type without cushion but with mamelon, and so on. The base, cushion, or umbilical hollow is open in front and continuous with the skin of the abdomen in something like 18.75 per cent of the cases. When the surrounding skin inclines gradually toward the umbilical depres- sion by a gentle slope, no prominence can be distinguished. In such cases we are dealing with an umbilicus without cushion. More frequently the base of the umbilical depression is surrounded by a circular elevation, a veritable cutaneous cushion. In about 6 per cent of the cases this cushion is complete and forms a uniform elevation, completely surrounding the cutaneous orifice of the umbilical depression. Ordinarily it is incomplete and occupies only a portion of the circum- ference of the umbilicus; for example, half of the circumference, the superior or inferior, or one of its lateral walls. This cushion then takes the form of a half- moon, a crescent, etc., and gives rise to numerous varieties in the appearance of the umbilicus. The bottom of the umbilical depression, despite Catteau’s description, is not always occupied by an eminence carrying the cicatrix. (a) Asmoothdepression. In 34 cases Bert and Viannay found the bottom absolutely smooth, without any trace of elevation or mamelon. In these cases the umbilical depression was also regular and infundibular in form. They observed two varieties: In the first the umbilical orifice may be large, widely open, presenting at its extreme bottom the cicatrix, smooth or depressed, and having a